摘要
目的探讨经鼻高流量氧疗(HFNC)与无创正压通气交替治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者的临床疗效。方法将衢州市中医医院ICU收治的90例COPD伴Ⅱ型呼吸衰竭的患者分为观察组(45例)和对照组(45例)。对照组患者在常规治疗基础上实施无创正压通气治疗,观察组患者在常规治疗基础上实施HFNC-无创正压通气交替治疗。比较两组患者的治疗有效率、住院时间、气管插管率、28 d病死率、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、pH值、呼吸频率、心率以及痰液黏稠度等。结果治疗后,观察组患者治疗有效率(91.1% vs. 73.3%,χ^2= 4.865,P= 0.027)、PaO2 [(79 ± 15)mmHg vs.(69 ± 14)mmHg,t= 3.006,P= 0.003]及pH值[(7.53 ± 1.01)vs.(7.04 ± 1.06),t= 2.245,P= 0.027]均较对照组显著升高;而观察组患者ICU住院时间[(8.6 ± 1.6)d vs.(10.4 ± 2.5)d,t= 4.091,P < 0.001]、气管插管率(6.7% vs. 24.4%,χ^2= 5.414,P= 0.020)、PaCO2 [(52 ± 13)mmHg vs.(70 ± 13)mmHg,t= 6.564,P < 0.001]、呼吸频率[(77 ± 8)次/min vs.(88 ± 9)次/min,t= 6.310,P < 0.001]及心率[(17.6 ± 3.0)次/min vs.(19.0 ± 2.9)次/min,t= 2.238,P= 0.028]均较对照组显著降低。观察组患者治疗后痰液黏稠度Ⅰ度20例、Ⅱ度13例、Ⅲ度12例,对照组患者治疗后痰液黏稠度Ⅰ度9例、Ⅱ度15例、Ⅲ度21例,两组患者治疗后痰液黏稠度比较,差异有统计学意义(χ^2= 3.876,P= 0.049)。结论对COPD合并Ⅱ型呼吸衰竭的患者,运用HFNC与无创正压通气交替疗法是一种新的有潜力的呼吸支持方式。
Objective To explore the clinical effect of high-flow nasal cannulae (HFNC) and non-invasive positive pressure ventilation alternately on chronic obstructive pulmonary disease (COPD) patients with type Ⅱ respiratory failure. Methods Totally 90 patients of COPD complicated with type Ⅱ respiratory failure were divided into the observation group (45 cases) and control group (45 cases) in the Department of Intensive Care Unit, Quzhou Municipal Hospital of TCM. The patients in the control group were treated with non-invasive positive pressure ventilation on the basis of routine treatment, and the patients in the observation group were alternately treated with HFNC-non-invasive positive pressure ventilation on the basis of routine treatment. The therapeutic effective rate, hospital stay, tracheal intubation rate, 28-day mortality, partial pressure of carbon dioxide in arterial (PaCO2), arterial partial pressure of oxygen (PaO2), pH value, respiratory rate, heart rate and sputum viscosity were compared between these two groups. Results After treatment, in the observation group, the effective rate (91.1% vs. 73.3%,χ^2 = 4.865, P = 0.027), PaO2 [(79 ± 15) mmHg vs.(69 ± 14) mmHg, t = 3.006, P = 0.003] and pH value [(7.53 ± 1.01) vs.(7.04 ± 1.06), t = 2.245, P = 0.027)] were significantly higher, while the hospital stay of ICU [(8.6 ± 1.6) d vs.(10.4 ± 2.5) d, t = 4.091, P < 0.001], tracheal intubation rate (6.7% vs. 24.4%,χ^2 = 5.414, P = 0.020), PaCO2 [(52 ± 13) mmHg vs.(70 ± 13) mmHg, t = 6.564, P < 0.001], respiratory rate [(77 ± 8) breaths/min vs.(88 ± 9) breaths/min, t = 6.310, P < 0.001] and heart rate [(17.6 ± 3.0) beats/min vs.(19.0 ± 2.9) beats/min, t= 2.238, P= 0.028] were significantly lower than those in the control group. There were 20 cases of degree Ⅰ sputum viscosity, 13 cases degree Ⅱ and 12 cases degree Ⅲ in the observation group after treatment, and 9 cases degree Ⅰ, 15 cases degree Ⅱ and 21 cases degree Ⅲ in the control group after treatment. There was significant difference in the sputum viscosity between these two groups (χ^2= 3.876, P= 0.049). Conclusion The alternative therapy of HFNC and non-invasive positive pressure ventilation is a new potential respiratory support method for COPD patients complicated with type Ⅱ respiratory failure.
作者
余优琴
诸葛建成
王春林
刘吉庆
汪芬华
叶燕飞
Yu Youqin;Zhuge Jiancheng;Wang Chunlin;Liu Jiqing;Wang Fenhua;Ye yanfei(Department of Nursing, Quzhou Municipal Hospital of TCM, Quzhou 324002, China;Department of Intensive Care Unit, Quzhou Municipal Hospital of TCM, Quzhou 324002, China)
出处
《中华危重症医学杂志（电子版）》
CAS
CSCD
2019年第2期104-108,共5页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
衢州市2016年度指导性科技项目(2016100)
关键词
肺疾病
慢性阻塞性
经鼻高流量氧疗
无创正压通气
呼吸衰竭
Pulmonary disease, chronic obstructive
High-flow nasal cannulae
Non-invasive positive pressure ventilation
Respiratory failure
作者简介
通信作者:诸葛建成,Email:2456958062@qq.com.
